(g) “Dispute liability”

Summary

Under specific circumstances, a claims administrator may dispute liability for the medical treatment requested in a Request for Authorization (RFA).

Regulation 9792.6.1 defines dispute liability as an assertion by the claims administrator that a factual, medical, or legal basis exists, other than medical necessity, that precludes compensability on the part of the claims administrator. This can include a not-accepted body part or injury, or not accepted liability for a specific medical treatment.